Treatment of Traumatic Brain Injury (TBI)

Rudolph C. Hatfield, PhD., edited by Kathryn Patricelli, MA

The treatment of a TBI is designed to assist the person in regaining as much of their functioning as is possible given the severity of their injury. The approach to treatment depends on many different factors that can affect the outcome of the treatment. Some of these factors are quite obvious and others may not seem to be very obvious. Just a few of the factors that affect recovery include:

Type of Injury, Location, and Severity: The type of TBI, the location of the injury in the brain, and the severity of the injury often play an important part in the recovery of the person. For example, people that have penetrating (open) head injuries often only have a few issues related to the specific area of their brain injury. However, people that have traumatic closed head injuries often have much more extensive issues that go beyond the specific areas where the brain has been impacted.

Length of Unconsciousness and Posttraumatic Amnesia: Factors that also heavily influence recovery are the length of time that a person is unconscious following the injury and the length of any posttraumatic amnesia they have. Typically, people who are unconscious for longer periods of time and/or suffer from posttraumatic amnesia for more than 24 hours have overall poorer outcomes and responses to treatment. The length of posttraumatic amnesia is a very good predictor of a person's potential for recovery. However, it is not a perfect predictor and some people who have long periods of posttraumatic amnesia do experience significant recovery.

Pre-Existing Factors: There are numerous pre-existing conditions that can interact with a TBI and affect the response to treatment. Just a few of these that can affect the outcome include:

having a prior substance abuse problem - this often results in a poorer response to treatment and poorer outcomes. Of course, developing a substance abuse problem after TBI can also slow down one's recovery.

having a prior diagnosis of some other form of mental illness, certain types of medical conditions that existed before the person experienced a TBI such as having a prior stroke, heart disease, diabetes, or some other type of disability/disorder .

a person's level of social support (support from family and/or friends)

a person's age often can affect their ability to recover such that older people will often have less potential for recovery than younger people, although this is not always the case.

Emotional/Psychological Reactions to the TBI: The development of psychological or emotional issues because of having a TBI can slow down a person's recovery. This can include the development of a trauma or stress related problem such as post-traumatic stress disorder (PTSD). It could include depression, feeling as if one can no longer cope, and becoming overwhelmed. Some people also begin to abuse drugs or alcohol, which can affect the treatment outcome.

Access to Treatment: The treatment is most effective when it can be delivered as soon as possible after the injury and when the person is ready to receive treatment. People who have head injuries and do not get treatment as soon as they are able to participate in treatment related activities will often experience poorer outcomes. Certain medical interventions that can be performed in the very early stages after a person has suffered a TBI can also help to set the stage for a better outcome. These include removing blood clots from the brain, giving certain types of medications that can help to reduce the damage, etc.

Again, there are other many factors that can influence the outcome of any single case. It is also important to understand that researchers are learning that the brain does have a capacity to repair itself to some extent. This capacity is often referred to as neuroplasticity. However, there is a limit to amount of the recovery that can happen in anyone. People who suffer extensive damage to the brain may not be able to experience a full recovery. There is also probably some level of remaining damage in most people who suffer moderate to severe TBI's, even though they show a good response to treatment.

Sometimes, treatment can result in different areas of the brain reforming or rewiring themselves to take over important functions that were once controlled by the parts of the brain that have been damaged by a TBI. However, as you might expect there are limitations on how much functioning can be taken over by different parts of the brain.

The approach to treatment for a person with a TBI is a team one where members work together to assist the person to regain as much recovery as possible. Team members are specialists who focus on their area of specialty and communicate with other team members regarding the person's progress. The treatment providers for people who have a TBI come from many different backgrounds and often have different levels of contribution to the recovery of a person. Some of the types of treatment providers that assist the person with a TBI during recovery include:

Physicians: Medical doctors can contribute quite a bit to recovery of a TBI. Doctors typically oversee the entire recovery process, refer the person to other specialists, and provide medicines and other medical procedures such as surgeries to assist in the person's recovery. There different types of specialists that get involved in the treatment process including:

Rehabilitation Physicians: medical doctors who are trained in the process of rehabilitation

Other Specialists.

Neuropsychologists: Neuropsychologists are psychologists with specialized training in brain behavior relationships. They may or may not perform psychotherapy. They can typically assess the individual's level of functioning and determine what areas of cognition are damaged and require extensive treatment. In addition, they can continue to follow the person, reassess them as they are go through treatment, determine the effects of the treatment, and make suggestions as to what other areas to continue to concentrate on.

Different Types of Therapists: There are many types of therapists that contribute to the recovery process. Just a few of these include:

Physical therapists: Provide therapy to regain physical functioning. The use of movement and exercise therapy can also help to rewire the brain.

Occupational therapists: Provide therapy to assist a person to relearn or to better perform everyday actions of living such as dressing, making meals, washing oneself, etc.

Recreational therapists: Use certain types of games and other activities to help a person regain functioning.

Psychologists or counselors: Assist people with a TBI to address many of the emotional issues that have occurred because of their experience. Some psychologists may also provide therapy that can assist people to improve their attention, memory, problem-solving, etc.

Social workers and case managers: Often help to organize the entire treatment process and to get needed resources for the person with a TBI such as a place to live, equipment to assist them, help them get insurance benefits, etc. In addition, social workers can also provide therapy to assist an individual with their emotional reaction to their TBI.